71 - Implementation of an OR Surgical Count Bundle to Improve Accuracy of the Instrument, Sharp and Sponge Counts
Background Information Surgical count discrepancies are common, occurring as often as one in eight cases. They most often involve documentation and counting errors of instruments, sharps and sponges. An audit of compliance with the Operating Room (OR) counting protocol revealed that only 74% of counts were performed appropriately and only 65% of counts were performed in a standardized manner. Project Aim To increase baseline OR surgical count compliance by 25% by May 2020. Methodology Members of the multidisciplinary OR team at an academic medical center in Los Angeles, CA observed 31 surgical counts to document the baseline compliance to the current counting protocol, using a data recording sheet, over a two-week period. The auditor collected data on how well staff performed: a two-person visual identification of countable items, saving protocol sheets and wrappers for soft goods, and placing sponges in count bags for visual inspection. The OR Surgical Count Improvement Bundle was introduced and incorporated over a three- month period. The bundle consists of 1) a location for all countable wrappers and inventory forms 2) standardized whiteboard setup with clear locations for countable items 3) an innovative supplemental technology that uses product-specific barcodes to identify sponges that were used during a given procedure to help support the manual counting efforts. After the implementation, 32 additional observations of the counting process were conducted over two weeks to measure the effectiveness of the interventions. The study team will continue auditing the counting process monthly, until May 2020 using the same direct observation method. Conclusion The post-intervention counting audit demonstrated improvement in the counting process compared to baseline. Appropriateness of counting improved from 74% to 94% (27% improvement). The two-person visual verification of soft goods increased from 74% to 97% (31% improvement) but the visual verification of instruments still needs improvement. There was also an 83% improvement in the percent of cases where wrappers are saved for soft goods and inventory forms, where the count is performed in a standardized manner and where countable sponges are placed in count bag. The only audit question where improvement was not observed was saving instrument inventory forms for reference during the case. This represents an opportunity to educate staff and investigate if there are barriers to saving the forms. Implications Although the surgical count bundle has successfully improved the compliance and standardization of the counting process, continuous staff education and reinforcement is needed to sustain improvement efforts.